降低產房監測高危險妊娠胎心音無效警示率

Reducing the Invalid Alarm Rate for Fetal Heartbeat Monitoring in High-Risk Pregnancies in the Delivery Room

背景：胎心音監測反映胎兒於待產過程的狀況及決定生產的時機，高危險妊娠婦女的待產過程須正確且完整地監測胎心音，臨床上常出現無效性警示，容易造成護理師的警示疲勞、待產婦與家屬心理的緊張及不信任，甚至可能因警示疲勞而忽略，錯失挽救胎兒生命。調查顯示胎心音無效警示率高達65.1%，其原因為缺乏高危險妊娠胎心音監測的標準作業規範及衛教不完全等，引發專案小組改善動機。
目的：降低監測高危險妊娠胎心音無效警示率至42.8%以下。
解決方案：根據病人安全醫療儀器管理指引，本專案團隊制定高危險妊娠胎心音監測標準和程序、製作衛教指導單張和多媒體衛教影片。入院時護理師給予待產婦衛教指導單張及解釋監測目的和注意事項。另邀請資深護理師分享照顧高危險妊娠的困境經驗，產科醫師和護理師共同提出監測的適當解決方案，以降低胎心音無效性警示的情形。
結果：高危險妊娠胎心音監測無效警示率，由專案實施前的65.1%降低至21.3%；胎心音監測的平均完整率由41.7%提升至100%。
結論：本專案有效降低產房護理師高危險妊娠胎心音監測無效警示率，並提升監測完整性，降低待產婦與家人的緊張與焦慮，增加高危險妊娠待產婦的照護品質。

Background & Problems: Fetal heartbeat (FHB) monitoring is used to monitor the condition of a fetus in the uterus and estimate the expected time of delivery. It is crucial to accurately and comprehensively monitor fetal heart beats in high-risk pregnancies. However, invalid alarms frequently occur in clinical environments, easily promoting alarm fatigue among nurses and causing anxiety and distrust in the laboring women and their families. Health professionals may ignore valid alarms due to alarm fatigue and miss the opportunity to save a fetus’life. A survey in our hospital identified invalid alarm rates for fetal heart beats as high as 65.1%, with causes including a lack of standard operating procedures for FHB monitoring in high-risk pregnancies and incomplete health education.
Purpose: This project was developed to reduce the rate of invalid alarms in FHB monitoring in high-risk pregnancies to less than 42.8%.
Resolutions: According to patient safety references for medical equipment management, our team established FHB monitoring standards and procedures for high-risk pregnancies. We edited FHB monitoring nursing guidance leaflets and multimedia health education videos. Nurses distributed the health education leaflets and explained the purpose and precautions during labor to expectant mothers at hospital admission. We invited nurses to share the dilemmas of caring for high-risk pregnancy experiences with nurses and obstetricians. Obstetricians and nurses proposed joint solutions for monitoring to improve the feasibility of comprehensive FHB monitoring and reduce the rate of invalid alarms.
Results: The invalid alarm rate associated with FHB monitoring in high-risk pregnancies was reduced from 65.1% to 21.3%. In addition, the integrity of FHB monitoring was increased from 41.7% to 100%.
Conclusions: This project effectively reduced the invalid alarm rate for delivery room nurse FHB monitoring in high-risk pregnancies and improved the integrity of this monitoring procedure. Adopting this approach has the potential of reducing anxiety and distrust in women in labor and their families, thereby enhancing the quality of care provided to these women experiencing high-risk pregnancies.